{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T18:52:30Z","timestamp":1788288750805,"version":"build-2803163510"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Chronic intractable postherpetic neuralgia (PHN) is a significant sequel of herpes zoster and significantly impacts patients\u2019 quality of life. Although some pharmacotherapies, interventional approaches, and neural modulation have been recommended as clinical options, their efficacy is limited. Here, we reported the efficacy and safety of a standardized therapeutic approach with CT-guided intervertebral foramen injection of ozone (IVFO) in patients with chronic intractable thoracic and lumbar (PHN) (<jats:italic>n<\/jats:italic>\u202f=\u202f56) who had been tolerant or insensitive to first-line drugs, such as gabapentin (GBP) or pregabalin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Visual analogue scale (VAS), quantitative sensory testing (von Frey filaments only), and infrared thermography were used to identify and quantify the pain intensity, area of mechanical hyperalgesia, and skin temperature in the included patients with PHN before and after IVFO treatment. Moreover, the dosage of and the time to discontinue GBP and complications were also documented after discharge from hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In this 1\u202fyear follow-up study, the primary endpoint outcomes measured by VAS showed that IVFO treatment resulted in significant relief of spontaneous pain by 59.19% [2.67\u202f\u00b1\u202f0.66] for immediate, 68.18% [2.08\u202f\u00b1\u202f0.89] for half year and 70.79% [1.91\u202f\u00b1\u202f1.19] for 1\u202fyear after discharge vs. admission, dramatic decrease in spatial area of mechanical hyperalgesia by 52.35% [3.11\u202f\u00b1\u202f0.70] for immediate and 87.41% [0.82\u202f\u00b1\u202f0.50] for half year after discharge vs. admission and skin temperatures by 63.01% [0.85\u202f\u00b1\u202f0.35] for immediate after discharge vs. admission. Moreover, half of the patients stopped taking GBP 3\u202fmonths after discharge. No serious complications were reported during the one-year follow-up after IVFO treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These results suggest that CT-guided IVFO treatment is a safe and effective interventional approach for the relief of chronic, drug-resistant, thoracic and lumbar PHN.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1602689","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T04:11:08Z","timestamp":1747627868000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy and safety of ozone injection into the intervertebral foramen for treating patients with chronic, intractable postherpetic neuralgia: a one-year follow-up study"],"prefix":"10.3389","volume":"16","author":[{"given":"Jiang-Lin","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai-Li","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang-Bo","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia-Gui","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia-Shuang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"ITC19","DOI":"10.7326\/AITC201808070","article-title":"Herpes zoster","volume":"169","author":"Schmader","year":"2018","journal-title":"Ann Intern Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.4065\/82.11.1341","article-title":"A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. [published correction appears in Mayo Clin Proc. 2008;83(2):255]","volume":"82","author":"Yawn","year":"2007","journal-title":"Mayo Clin Proc"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e004833","DOI":"10.1136\/bmjopen-2014-004833","article-title":"Systematic review of incidence and complications of herpes zoster: towards a global perspective","volume":"4","author":"Kawai","year":"2014","journal-title":"BMJ Open"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1186\/1471-2334-14-529","article-title":"ARIZONA study: is the risk of post-herpetic neuralgia and its burden increased in the most elderly patients?","volume":"14","author":"Duracinsky","year":"2014","journal-title":"BMC Infect Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"4429","DOI":"10.1172\/JCI121484","article-title":"Th1 memory differentiates recombinant from live herpes zoster vaccines","volume":"128","author":"Levin","year":"2018","journal-title":"J Clin Invest"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1526","DOI":"10.1056\/NEJMcp1403062","article-title":"Clinical practice. Postherpetic neuralgia","volume":"371","author":"Johnson","year":"2014","journal-title":"N Engl J Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1111\/ner.12208","article-title":"The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the Neuromodulation appropriateness consensus committee","volume":"17","author":"Deer","year":"2014","journal-title":"Neuromodulation"},{"key":"ref8","first-page":"263","article-title":"Clinical study of spinal cord stimulation and pulsed radiofrequency for Management of Herpes Zoster-Related Pain Persisting beyond Acute Phase in elderly patients","volume":"23","author":"Liu","year":"2020","journal-title":"Pain Physician"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"E487","DOI":"10.36076\/ppj.2020\/23\/E487","article-title":"Computed tomography-guided percutaneous Coblation of the thoracic nerve root for treatment of Postherpetic neuralgia","volume":"23","author":"Luo","year":"2020","journal-title":"Pain Physician"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1093\/icvts\/ivr081","article-title":"Does adding ketamine to morphine patient-controlled analgesia safely improve post-thoracotomy pain?","volume":"14","author":"Mathews","year":"2012","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"ref11","first-page":"553","article-title":"Painkilling effect of ozone-oxygen injection on spine and joint osteoarthritis","volume":"29","author":"Al-Jaziri","year":"2008","journal-title":"Saudi Med J"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/j.ejphar.2013.07.034","article-title":"Ozone oxidative postconditioning ameliorates joint damage and decreases pro-inflammatory cytokine levels and oxidative stress in PG\/PS-induced arthritis in rats","volume":"714","author":"Vaillant","year":"2013","journal-title":"Eur J Pharmacol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/S0306-9877(96)90016-X","article-title":"Does ozone therapy normalize the cellular redox balance? Implications for therapy of human immunodeficiency virus infection and several other diseases","volume":"46","author":"Bocci","year":"1996","journal-title":"Med Hypotheses"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e7586","DOI":"10.1136\/bmj.e7586","article-title":"SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials","volume":"346","author":"Chan","year":"2013","journal-title":"BMJ"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1097\/AJP.0000000000001226","article-title":"Computed tomography-guided dorsal root ganglion ozone injection combined with pulsed radiofrequency for acute herpes zoster neuralgia treatment of middle-aged and elderly people: a randomized, double-blinded, controlled trial","volume":"40","author":"Wang","year":"2024","journal-title":"Clin J Pain"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"23","DOI":"10.2147\/JPR.S333481","article-title":"Safety and efficacy of CT-guided pulsed radiofrequency combined with steroid and ozone injection-treated cervical 3-8 herpes zoster neuralgia using a posterior and upper quarter of the cervical foramina puncture approach","volume":"15","author":"Ma","year":"2022","journal-title":"J Pain Res"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1111\/j.1468-1331.2010.02999.x","article-title":"EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision","volume":"17","author":"Attal","year":"2010","journal-title":"Eur J Neurol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/S1474-4422(14)70251-0","article-title":"Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis","volume":"14","author":"Finnerup","year":"2015","journal-title":"Lancet Neurol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2138","DOI":"10.1093\/pm\/pnaa459","article-title":"Long-term results with adjuvant ozone therapy in the Management of Chronic Pelvic Pain Secondary to Cancer treatment","volume":"22","author":"Clavo","year":"2021","journal-title":"Pain Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.neulet.2008.06.036","article-title":"Effects of different concentrations of oxygen-ozone on rats\u2019 astrocytes in vitro","volume":"441","author":"Zhou","year":"2008","journal-title":"Neurosci Lett"},{"key":"ref21","first-page":"E673","article-title":"Intervertebral foramen injection of ozone relieves mechanical allodynia and enhances analgesic effect of gabapentin in animal model of neuropathic pain","volume":"20","author":"Luo","year":"2017","journal-title":"Pain Physician"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"300060520977416","DOI":"10.1177\/0300060520977416","article-title":"Efficacy of different interventions for the treatment of postherpetic neuralgia: a Bayesian network meta-analysis","volume":"48","author":"Wen","year":"2020","journal-title":"J Int Med Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1097\/AJP.0b013e3181dda1ac","article-title":"Pregabalin and transcutaneous electrical nerve stimulation for postherpetic neuralgia treatment","volume":"26","author":"Barbarisi","year":"2010","journal-title":"Clin J Pain"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.clinthera.2011.02.007","article-title":"Efficacy of pregabalin for peripheral neuropathic pain: results of an 8-week, flexible-dose, double-blind, placebo-controlled study conducted in China","volume":"33","author":"Guan","year":"2011","journal-title":"Clin Ther"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"771","DOI":"10.5021\/ad.2015.27.6.771","article-title":"Do interventional pain management procedures during the acute phase of herpes zoster prevent Postherpetic neuralgia in the elderly? A Meta-analysis of randomized controlled trials","volume":"27","author":"Jang","year":"2015","journal-title":"Ann Dermatol"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1602689\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T04:11:09Z","timestamp":1747627869000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1602689\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,19]]},"references-count":25,"alternative-id":["10.3389\/fneur.2025.1602689"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1602689","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,19]]},"article-number":"1602689"}}